title: Optimal revascularization strategies for percutaneous coronary intervention of distal anastomotic lesions after coronary artery bypass surgery.
abstract: OBJECTIVE
  To determine the best revascularization strategy when treating distal anastomotic lesions.
  
  
  BACKGROUND
  Distal anastomotic lesions are the most common reason for venous graft failure especially early after bypass surgery. However, the best percutaneous method for treating these lesions is still controversial.
  
  
  METHODS
  All patients from 2/2000 to 1/2011 who underwent percutaneous coronary intervention of bypass graft distal anastomotic lesions were retrospectively enrolled. Among the 139 patients included, 26 (18.7%) were treated with plain old balloon angioplasty (POBA), 68 (48.9%) with bare metal stents (BMS), and 45 (32.4%) with drug-eluting stents (DES).
  
  
  RESULTS
  Baseline characteristics were generally comparable among the 3 groups. At 6 months' follow-up, the highest rate of target lesion revascularization-major adverse cardiac events (TLR-MACE) was seen in the BMS group compared to the DES and POBA groups (16.2 vs. 2.2 vs. 3.8%, respectively, P=0.03), which was driven mainly by the highest rates of death and TLR in the BMS group (11.8 and 4.7%, respectively). At 1-year follow-up, a higher rate of TLR-MACE was seen in the BMS group compared to the DES and POBA groups (20.6 vs. 11.1 vs. 7.7%, respectively, P=0.19). After adjustment, on Cox regression analysis for hazard ratios, no significant differences were found among the 3 groups at 1-year follow-up of TLR-MACE.
  
  
  CONCLUSIONS
  When selecting the treatment modality for saphenous vein graft distal anastomotic lesions, BMS implantation should be discouraged while POBA and DES implantation can be performed with favorable long-term outcomes. The optimal treatment approach should be evaluated in large, randomized clinical trials.
authors.affiliation: MedStar Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Salem
authors.initials: S
authors.lastname: Badr
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Israel M
authors.initials: IM
authors.lastname: Barbash
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D023903:Coronary Restenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012086:Reoperation; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency